Let’s Talk About Data

As organized medicine gets more sophisticated in the ways it gathers, analyzes and presents volumes of data, the data itself provides answers to help us improve both science and practice.

Data is extraordinarily powerful in medicine. Frankly, as we move toward more management of populations of patients, data will drive even more of what we do.

For example:

• Data is why we no longer give two rescue breaths at the beginning of CPR;
• Data identified that MAST trousers (remember those, you old geezers?) hurt more than they helped in many cases of penetrating trauma;
• Data alerted us to the harmful effects of sublingual nifedipine for hypertensive crises (even in the face of doing a nice job decreasing elevated pressures);
• Data is why we mark our ambulances the way we do to increase visibility and reduce crashes;
• Data allowed us to change our glucose administration approaches when D50W became less available;
• Data gave us a glimpse into how often we had to reverse opiate administration (by us) in pediatric patients (almost zero);
• Data allows us to anticipate call volumes so we can staff and deploy appropriately during surge periods;
• Data allowed us to see how often we had potential Ebola calls during the Ebola crisis two years ago.

I know I sound like Mr. Obvious here, but I want to take it one step further.

Data is the foundation for an evidence-based practice of medicine—medicine that maximizes our ability to make a difference in the outcomes of our patients. The more accurate data we have about a particular condition or practice (or individual patient, for that matter), the easier it is to identify what really impacts their care in a positive way. We tend to think of the value of data in scientific publications, but it has just as much importance in our own practices.

If we believe we can make better decisions with more and better data (and I believe we all do), think about what we have ahead of us.

EMS has struggled with what really makes a difference since its inception. As we understand more (and we truly do), we are better at focusing on things that impact care versus things we’ve always seemed to focus on (response intervals, for instance, rather than neurologically intact survival from OOH cardiac arrest). We will see more and more focus on those things that really impact care in our population.

And if it really makes a difference, that’s how we should all be evaluated and compensated, which is the major directional change in the world of medicine today: accountability for solid performance in practices that improve outcome.

There is increasing recognition that EMS is a practice of medicine and, as such, should be treated the same way our peers in the House of Medicine are. But our data must be pristine. If we want to do this right and take better care of patients, we absolutely have to capture our patient assessments and observations accurately. We have to describe our impressions clearly. We have to record the results and responses (or lack of responses) to our interventions in detail. We have to articulate as much detail as we can so we can understand what we’re doing and what difference we’re making (or not).

Our data—our medical records, CAD data, nurses’ notes, physician documentation, etc.—must be able to tell the story and paint the picture of what we are doing and what happens based on that. It’s great patient documentation, and it’s great science.

I know, I know. Sometimes we think of it as the dreaded paperwork crap. I’ll admit, there’s always some of that. But it is so much bigger than that. We need to lead the way into these new, innovative practices, and with the spotlight slowly turning toward out-of-hospital care, we want to have answers to the questions.

We need to do a much better job of capturing accurate, complete info on everyone we have the privilege of caring for. Our patient care record should paint the picture of what we saw, what we did, what happened and everything in between.

As hospitals pay more attention to what EMS does, we have to pay attention to the accuracy with which we describe it.

I really do mean to be on a soapbox here. Our medical record is the signature of our work. So please make a conscious effort to focus on the accuracy and quality of our documentation. I know it’s an extremely boring topic (better than HIPAA, though, right?), but it’s so important and so much more than just completing the dreaded paperwork.

You and I would expect it if it were us on that stretcher.

Ed Racht, MD, is the chief medical officer for American Medical Response and associate medical director for Evolution Health. He has more than 20 years of experience in emergency medical services and healthcare systems.